Relationship between availability of physiotherapy services and ICU costs

The rehabilitation workforce in Brazil

BACKGROUND

The surge in individuals facing functional impairments has heightened the demand for rehabilitation services. Understanding the distribution of the rehabilitation workforce is pivotal for effective health system planning to address the population's health needs.

OBJECTIVE

To investigate the spatial and temporal dispersion of physical therapists, speech therapists, psychologists and occupational therapists across various tiers of care within Brazil's Unified Health System and its regions.

METHOD

This is an ecological time series study on the supply of rehabilitation professionals. Data were obtained from the National Register of Health Establishments from 2007 to 2020. The density of professionals was calculated per 10,000 inhabitants annually for Brazil and its five regions. The Joinpoint regression model was used to analyze the temporal trends of the density of professionals, considering a 95% confidence interval.

RESULTS

In 2020, the most notable concentrations of psychologists, speech therapists, and occupational therapists in Brazil were observed in the domain of Specialized Health Care, with densities of 0.60, 0.20, and 0.16 professionals per 10,000 inhabitants, respectively. Conversely, the highest density of physical therapists was found within Hospital Health Care, with a density of 1.19 professionals per 10,000 inhabitants. Notably, variations in professional dispersion across different regions were apparent. Primary Health Care exhibited the highest density of professionals in the Northeast region, while the Southern region accounted for the highest densities in all professional categories within Specialized Health Care. The southeast region exhibited the largest workforce within Hospital Health Care. A marked upsurge in professional availability was noted across all categories, notably in the occupational therapy sector within hospital care (AAPC: 30.8), despite its initial low density.

CONCLUSION

The implementation of public health policies played a significant role in the expansion of the rehabilitation workforce at all three levels of care in Brazil and its various regions from 2007 to 2020. Consequently, regional disparities and densities of professionals have emerged, mirroring patterns observed in low-income countries.

Approach to Intensive Care Costing and Provision of Cost-effective Care

Intensive care unit (ICU) service is resource-intense, finite, and valuable. The outcome of critically ill patients has improved because of a better understanding of disease pathology, technological developments, and newer treatment modalities. These improvements have however come at a price, with ICUs contributing significantly to health budgets. Several costing tools are used to assess cost. Accurate assessment has been hampered by the lack of standardized methodology and the heterogeneity of ICUs. In a costing exercise, the level of disaggregation (micro-costing vs gross-costing) and the method of costing (top-down vs bottom-up) need to be considered. Intensive care unit costing also needs to be viewed from the perspective of stakeholders. While all stakeholders aim to provide quality health care, objectives may vary. For the public health care provider, the focus is on optimizing expenditure; for the private health care provider it is bottomline; for a patient, it is affordability; for an insurance service provider, it is minimizing payout; and for the regulator, it is ensuring quality standards and fair pricing. The field of health economics deals with the application of the principles of cost-minimization, cost-effectiveness, cost-utility, and cost-benefit to identify treatments that result in the best outcome at the lowest cost, without limiting resources to other competing interests. In the ICU setting, studies on the efficient use of available resources, and interventions that reduce cost and minimize avoidable cost, would not only translate to cost savings, lives saved, and quality-adjusted life years gained but also enable policymakers to better allocate health care resources.

HOW TO CITE THIS ARTICLE

Chacko B, Ramakrishnan N, Peter JV. Approach to Intensive Care Costing and Provision of Cost-effective Care. Indian J Crit Care Med 2023;27(12):876-887.

A Rule Based Intelligent Software to Predict Length of Stay and the Mortality Rate in Trauma Patients in the Intensive Care Unit

Background

Intensive Care Unit (ICU) has the highest mortality rate in the world. ICU has special equipment that leads to the hospital's most costly parts. The length of stay in the ICU is a special issue, and reducing this time is a practical approach. We aimed to use artificial intelligence to help early and timely diagnosis of the disease to help with health.

Methods

We designed a rule-based intelligent system to predict the length of stay and the mortality rate of trauma patients in ICU. A neuro-Fuzzy and eight machine learning models were used to predict the mortality rate in trauma patients in ICU. The performances of these techniques were evaluated with accuracy, sensitivity, specificity, and area under the ROC curve. Decision-Table was used to predict the length of stay in trauma patients in ICU. For comparison, eight machine learning models were used. The method is compared based on Mean absolute error and relative absolute error (%).

Results

Neuro-Fuzzy expert system and Decision-Table showed better results than other techniques. Accuracy, sensitivity, specificity, and ROC Area of Nero-Fuzzy are 83.6735, 0.9744, 0.3000, 0.8379, and 1, respectively. The mean absolute error and Relative absolute error (%) of the Decision-Table model are 4.5426 and 65.4391, respectively.

Conclusion

Neuro-Fuzzy expert system with the highest level of accuracy and a Decision-Table with the lowest Mean absolute error, which are rule-based models, are the best models. Therefore, these models are recommended as a valuable tool for prediction parameters of ICU as well as medical decision-making.

COVID-19: the importance of physical therapy in the recovery of workers' health

Coronavirus disease 2019 (COVID-19) is likely to have a major impact on society and the economy since the illness is currently infecting a significant number of active workers in the industry and service sectors. The illness can have long-term consequences for patients, affecting their functional capacity and, consequently, their occupational performance. This study analyzed the effects of COVID-19 on occupational health, with a focus on the importance of physical therapy in rehabilitation. An integrative literature review was conducted based on articles retrieved from the PubMed, SciELO, and LILACS databases using the following keywords: COVID-19, physical therapy, rehabilitation, and occupational health. The search retrieved 1,308 studies, 15 of which met inclusion criteria for the review. A thorough assessment of the articles revealed four topics that corresponded to the results of this study: 1) effects of COVID-19 on occupational health; 2) physical therapy in mild and moderate cases without hospitalization; 3) physical therapy in hospitalized patients with COVID-19; 4) physical therapy in post-intensive care unit (ICU) recovery and after hospital discharge. The findings showed that COVID-19 can affect several physiological systems and have both short- and long-term effects on patients, including physical and psychological impairments. Physical therapists must be involved in the battle against this illness to help patients recover their physical function and return to work as quickly, safely, and effectively as possible.

Current Physical Therapy Practice in the Intensive Care Unit in Saudi Arabia: A Multicentre Cross-Sectional Survey

BACKGROUND

Early mobilisation of patients in the intensive care unit (ICU) is associated with positive health benefits. Research literature lacks insight into the current status of ICU physical therapy (PT) practice in the Kingdom of Saudi Arabia.

AIM

To determine the current standard of ICU PT practice, attitude, and barriers.

METHODS

A questionnaire was e-mailed to physiotherapists (PTs) working in the hospital. The questions pertained to experience, qualification, barriers, and most frequently encountered case scenarios in the ICU.

RESULTS

The response rate was 28.1% (124/442). Frequent cases referred to the PTs were traumatic paraplegia (n = 111, 89%) and stroke (n = 102, 82.3%) as compared to congestive heart failure (n = 20, 16.1%) and pulmonary infections (n = 7, 5.6%). The preferred treatment of choice among PTs was chest physiotherapy (n = 102, 82.2%) and positioning (n = 73, 58.8%), whereas functional electrical stimulation (n = 12, 9.6%) was least preferred irrespective of the condition. Perceived barriers in the ICU PT management were of low confidence in managing cases (n = 89, 71.7%) followed by inadequate training (n = 53, 42.7%), and the least quoted barrier was a communication gap between the critical care team members (n = 8, 6.4%).

CONCLUSION

PTs reported significant variation in the choice of treatment for different clinical cases inside ICU. The main barriers in the ICU setting were low confidence and inadequate training.

Barriers and challenges faced by Brazilian physiotherapists during the COVID-19 pandemic and innovative solutions: lessons learned and to be shared with other countries

The pandemic caused by SARS-CoV-2 that leads to COVID-19 has had an incalculable impact on society, services, and health professionals, including physiotherapists. The field of physiotherapy is currently facing ongoing challenges and pandemic-related repercussions, with Brazilian physiotherapists being especially affected. This article describes the current scenario in Brazil which has exposed the shortage of professionals and resources and reinforces the need for professional recognition, especially of those working in intensive care units. Barriers and challenges faced by Brazilian physiotherapists during the COVID-19 pandemic are described, followed by innovative solutions. Remote physiotherapy prior to the pandemic was merely one of many patient care options, but now has become a necessity, and several international organizations have provided guidelines for physiotherapists to follow, including guidelines on offering digital physiotherapy. Related demands, challenges, and perspectives of physiotherapy practice are likely to emerge amid the current uncertainties of the COVID-19 crisis, as well as during the post-pandemic period. The lessons learned by the Brazilian physiotherapy community may be of assistance to physiotherapists in other countries particularly those with comparable social and demographic characteristics.